Hematopathology Practice Questions

Q: A 50-year-old male presents with fatigue and generalized lymphadenopathy. A lymph node biopsy reveals a starry sky pattern. What is the most likely diagnosis?

Burkitt lymphoma. ***Burkitt lymphoma*** - Characterized by a **starry sky pattern** on histology due to numerous **macrophages** engulfing apoptotic cells [1], commonly associated with a **MYC** mutation. - Typical clinical presentations include **fast-growing lymphadenopathy** and possible **abdominal masses**, aligning with the patient's symptoms of fatigue and lymphadenopathy. *Diffuse large B-cell lymphoma* - Typically shows a variety of cellular patterns but does not exhibit the distinct **starry sky** pattern. - Often presents with **more aggressive symptoms** and is associated with **B symptoms** like fever and night sweats, which are not mentioned here. *Follicular lymphoma* - Histologically presents with **follicles and centrocytes**, differing from the **starry sky pattern** seen in Burkitt lymphoma. - Generally involves **indolent** symptoms, often more chronic than the acute presentation observed in this patient. *Hodgkin lymphoma* - Characterized by **Reed-Sternberg cells** and typically shows a **continuous** pattern of lymph node involvement, unlike the **starry sky** pattern. - Usually associated with **B symptoms** like fever and weight loss, which are not reported in this case. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, p. 606.

Q: A 6-year-old boy presents with a rapidly enlarging jaw mass. Histology reveals a 'starry sky' appearance. What is the most likely diagnosis?

Burkitt lymphoma. ***Burkitt lymphoma*** - Characterized by a **rapidly enlarging jaw mass** [1] and the presence of a **'starry sky' appearance** [2] on histology due to interspersed macrophages in a background of dense, proliferative B-lymphoid tissue. - Most common in children [1], often associated with **endemic forms** in Africa linked to **EBV** infection. *Acute lymphoblastic leukemia* - Typically presents with **bone marrow infiltration**, leading to symptoms like **anemia**, **thrombocytopenia**, and **leukopenia**, rather than a localized mass. - Histological findings would show **lymphoblasts** but not a 'starry sky' pattern. *Hodgkin lymphoma* - Generally presents with **painless lymphadenopathy** rather than a **rapidly growing jaw mass**, and involves **Reed-Sternberg cells** on histology. - The classic presentation does not include the characteristic 'starry sky' appearance associated with Burkitt lymphoma. *Diffuse large B-cell lymphoma* - Often presents as a **mass** but is more typically seen in older adults and does not have the **'starry sky' appearance** associated with Burkitt lymphoma. - Histologically, it would show **large B-cells** and is less aggressive in its clinical presentation compared to Burkitt lymphoma. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 605-606. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, p. 606.

Q: In the calculation of Mean Corpuscular Volume (MCV), which formula is correct?

(Hematocrit × 10) / RBC count. **Correct: (Hematocrit × 10) / RBC count** - This formula correctly calculates the **Mean Corpuscular Volume (MCV)**, representing the average volume of red blood cells. - The multiplication by **10** is included to adjust units, typically with hematocrit in percentage and RBC count in millions/µL, to yield MCV in femtoliters (fL). - Normal MCV range: 80-100 fL *Incorrect: (Hematocrit × 100) / RBC count* - This formula is incorrect because multiplying the hematocrit by **100** instead of 10 would lead to an excessively large and inaccurate MCV value (10 times higher than actual). - The standard unit conversion requires a factor of **10** to correctly express MCV in femtoliters. *Incorrect: (Hematocrit × 10) / Total blood volume* - This formula is incorrect as **total blood volume** is not a component used in the direct calculation of Mean Corpuscular Volume. - MCV is derived from the hematocrit and RBC count, reflecting the average size of individual red blood cells. *Incorrect: (Hemoglobin × 10) / Hematocrit* - This formula is incorrect for calculating MCV; it actually represents the formula for **Mean Corpuscular Hemoglobin Concentration (MCHC)**, which measures the average concentration of hemoglobin in red blood cells. - MCV specifically measures the **average volume** of red blood cells, not their hemoglobin content or concentration.

Q: A 30-year-old male presents with fatigue and easy bruising. A peripheral blood smear shows blasts with Auer rods. Which cytogenetic abnormality is most likely associated with his condition?

t(15;17). ***t(15;17)*** - The presence of **Auer rods** in blasts strongly suggests **Acute Myeloid Leukemia (AML)**, specifically the **M3 subtype** (Acute Promyelocytic Leukemia or APL) [1]. - **APL** is classically associated with the **t(15;17) translocation**, which involves the **PML** and **RARA** genes [1]. *t(8;21)* - This translocation is associated with another subtype of **AML**, specifically **AML with maturation** (M2), but it is not typically linked to the prominent presence of **Auer rods** like APL [1]. - While it is a recurrent cytogenetic abnormality in AML, it does not fit the classic presentation as well as t(15;17). *inv(16)* - The **inv(16)** (or t(16;16)) abnormality is characteristic of **AML with eosinophilia** (M4eo), a different subtype of AML [1]. - While it can be associated with some myeloid differentiation, it's not the primary association with abundant **Auer rods** and the classic APL picture [1]. *t(9;22)* - This translocation, also known as the **Philadelphia chromosome**, is primarily associated with **Chronic Myeloid Leukemia (CML)**. - Although it can also be found in some cases of acute lymphoblastic leukemia (ALL) and rarely in AML, it is not consistently associated with the presence of **Auer rods** and is not the most likely diagnosis in this clinical context. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 620-622.

Q: Which condition is most commonly associated with the presence of Reed-Sternberg cells in a lymph node biopsy?

Hodgkin's lymphoma. ***Hodgkin's lymphoma*** - The presence of **Reed-Sternberg cells** is a hallmark feature of Hodgkin's lymphoma, indicating **malignancy of lymphoid tissue** [1]. - These giant cells are often associated with **lymph node enlargement** and may present with **B symptoms** (fever, weight loss, night sweats) [1]. *Non-Hodgkin's lymphoma* - Does not typically show **Reed-Sternberg cells**, instead featuring a variety of **cell types** depending on the specific subtype. - Associated with **larger, often multiple lymphoid nodes**, but lacks the distinctive cell morphology seen in Hodgkin's lymphoma. *Multiple myeloma* - Characterized by the proliferation of **monoclonal plasma cells** in the bone marrow, not Reed-Sternberg cells. - Patients may exhibit **bone pain**, **anemia**, and **renal problems**, which are unrelated to Reed-Sternberg presence. *Leukemia* - Primarily involves the **bone marrow** and **blood**, not lymph nodes, and does not feature Reed-Sternberg cells. - Symptoms are more related to **cytopenias** and the **overproduction of abnormal leukocytes** rather than lymphadenopathy. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 614-618.

Q: A peripheral blood smear from a patient with a history of alcohol abuse shows hypersegmented neutrophils and oval macrocytes. Which underlying condition is most likely?

Folate Deficiency. ***Folate Deficiency*** - Hypersegmented neutrophils and **oval macrocytes** are key features indicative of **megaloblastic anemia** [1], primarily resulting from folate deficiency. - Alcohol abuse can impede folate absorption, leading to significant deficiencies and is commonly associated with these laboratory findings [2]. *Lead Poisoning* - Typically shows **basophilic stippling** of red blood cells and does not lead to hypersegmented neutrophils. - Presents with **anemia**, but the morphology is different, lacking the macrocytosis seen in folate deficiency. *Iron Deficiency Anemia* - Characterized by **microcytic hypochromic red blood cells** on blood smear, which differs from the **macrocytic** picture seen in this case. - Does not present with hypersegmented neutrophils, making it an unlikely cause here. *Thalassemia* - Presents with **microcytic anemia** and target cells, rather than macrocytic changes. - The findings of hypersegmented neutrophils and oval macrocytes are inconsistent with thalassemia's characteristic features. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 593-594. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 594-595.

Q: A peripheral blood smear shows target cells, poikilocytosis, and basophilic stippling. Which condition is most likely associated with these findings?

Thalassemia. ***Thalassemia*** - **Target cells**, **poikilocytosis**, and **basophilic stippling** are classic findings in thalassemia due to defective hemoglobin synthesis leading to an accumulation of unassembled globin chains [1]. - The abnormal globin chains precipitate, damaging red blood cell membranes, and leading to their premature destruction and characteristic dysmorphic features [1]. *Iron Deficiency Anemia* - This condition primarily presents with **microcytic, hypochromic red cells** and often significant anisocytosis (variation in size) and poikilocytosis (variation in shape), but **target cells** and **basophilic stippling** are not typically prominent features [2]. - While red cell morphology can be abnormal, the combination described is not characteristic of uncomplicated iron deficiency. *Sideroblastic Anemia* - Characterized by **ring sideroblasts** in the bone marrow, meaning iron accumulates in the mitochondria around the nucleus of erythroid precursors. Peripheral smear findings are often dimorphic, with some microcytic hypochromic cells and some larger, normochromic cells, and occasional **Pappenheimer bodies** (siderotic granules). - While some poikilocytosis might be present, extensive **target cells** and **basophilic stippling** are not the hallmark features. *Pernicious Anemia* - This is a type of **macrocytic anemia** caused by vitamin B12 deficiency (often due to intrinsic factor deficiency). - Peripheral smear shows **macro-ovalocytes**, **hypersegmented neutrophils**, and moderate to severe anisocytosis and poikilocytosis, but not target cells or basophilic stippling. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, p. 648. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 590-591.

Q: A 28-year-old woman presents with intermittent fever and joint pain. A biopsy of the lymph node reveals large, binucleated cells with prominent nucleoli. Which diagnostic test would confirm the probable diagnosis?

CD30 and CD15 immunohistochemistry. ***CD30 and CD15 immunohistochemistry*** - The presence of **large, binucleated cells with prominent nucleoli** (Reed-Sternberg cells) in a lymph node biopsy is highly characteristic of **Hodgkin lymphoma** [1]. - **Reed-Sternberg cells** typically express **CD30 and CD15**, and immunohistochemical staining for these markers is crucial for confirming the diagnosis of Hodgkin lymphoma [2]. *Bone marrow biopsy* - While a bone marrow biopsy may be performed for **staging** in Hodgkin lymphoma to check for marrow involvement, it is not the primary diagnostic test to confirm the initial diagnosis. - The characteristic Reed-Sternberg cells are found in the lymph nodes, not routinely in the bone marrow unless there is advanced disease [1]. *Serum lactate dehydrogenase* - **Serum LDH** can be elevated in various lymphomas and other conditions, indicating high tumor burden or cell turnover. - However, it is a **non-specific marker** and cannot confirm the specific diagnosis of Hodgkin lymphoma; it is often used for prognostication and monitoring rather than definitive diagnosis. *Peripheral blood smear* - A **peripheral blood smear** may show non-specific findings such as anemia or leukocytosis, but it does **not typically reveal Reed-Sternberg cells**. - Hodgkin lymphoma is primarily a nodal disease, and its diagnosis relies on lymph node biopsy, not examination of peripheral blood [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 614-616. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 616-618.

Q: Which of the following conditions is associated with elevated leukocyte alkaline phosphatase levels?

Polycythemia vera. ***Polycythemia vera*** - **Leukocyte alkaline phosphatase (LAP)** levels are typically **elevated** in polycythemia vera and other myeloproliferative disorders [1]. [2] - This elevation is due to the increased activity of **mature neutrophils**, which contain the LAP enzyme. *Pernicious anemia* - Pernicious anemia is a **megaloblastic anemia** caused by vitamin B12 deficiency. - It is not typically associated with elevated LAP levels; rather, LAP levels are often **normal or decreased** in certain anemias. *Sickle cell anemia* - Sickle cell anemia is a **hemolytic anemia** characterized by abnormal hemoglobin. - While patients can have elevated WBC counts during crises, LAP levels are generally **normal or decreased** and not a diagnostic feature. *Plummer Vinson syndrome* - Plummer-Vinson syndrome is characterized by **iron deficiency anemia**, dysphagia due to esophageal webs, and glossitis. - LAP levels are not typically affected by this condition and are usually **normal**. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 614-615. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 626-627.

Q: A 70-year-old man presents with weight loss, night sweats, and an abdominal mass. A CT scan reveals a large mesenteric mass, and a biopsy shows sheets of large lymphoid cells. What is the likely diagnosis?

Non-Hodgkin lymphoma. ***Non-Hodgkin lymphoma*** - The presence of a **large mesenteric mass** with sheets of **large lymphoid cells** on biopsy is characteristic of non-Hodgkin lymphoma, especially in older adults [1]. - Symptoms such as **weight loss** and **night sweats** align with the clinical presentation of aggressive non-Hodgkin lymphoma [1]. [2] *Multiple myeloma* - Typically presents with **bone pain**, **anemia**, and high levels of **monoclonal proteins**, not primarily with a mesenteric mass [3]. - Characterized by **punched-out** lytic lesions on imaging rather than large lymphoid masses. *Hodgkin lymphoma* - Often presents with **lymphadenopathy** and **Reed-Sternberg cells**, and less commonly with mesenteric masses [1]. - Frequently associated with **B symptoms**, but the predominant presentation here suggests a different diagnosis [2]. *Chronic lymphocytic leukemia* - Generally results in **lymphocytosis** and may involve lymph nodes but does not typically present with a large abdominal mass. - Usually presents insidiously and may show **splenomegaly**, but is not associated with sheets of large lymphoid cells seen in this case.

Question 1

A 50-year-old male presents with fatigue and generalized lymphadenopathy. A lymph node biopsy reveals a starry sky pattern. What is the most likely diagnosis?

Accepted Answer

Burkitt lymphoma

Answer

Hodgkin lymphoma

Answer

Diffuse large B-cell lymphoma

Answer

Follicular lymphoma

Question 2

A 6-year-old boy presents with a rapidly enlarging jaw mass. Histology reveals a 'starry sky' appearance. What is the most likely diagnosis?

Accepted Answer

Burkitt lymphoma

Answer

Hodgkin lymphoma

Answer

Diffuse large B-cell lymphoma

Answer

Acute lymphoblastic leukemia

Question 3

In the calculation of Mean Corpuscular Volume (MCV), which formula is correct?

Accepted Answer

(Hematocrit × 10) / RBC count

Answer

(Hemoglobin × 10) / Hematocrit

Answer

(Hematocrit × 100) / RBC count

Answer

(Hematocrit × 10) / Total blood volume

Question 4

A 30-year-old male presents with fatigue and easy bruising. A peripheral blood smear shows blasts with Auer rods. Which cytogenetic abnormality is most likely associated with his condition?

Accepted Answer

t(15;17)

Answer

t(8;21)

Answer

inv(16)

Answer

t(9;22)

Question 5

Which condition is most commonly associated with the presence of Reed-Sternberg cells in a lymph node biopsy?

Accepted Answer

Hodgkin's lymphoma

Answer

Non-Hodgkin's lymphoma

Answer

Multiple myeloma

Answer

Leukemia

Question 6

A peripheral blood smear from a patient with a history of alcohol abuse shows hypersegmented neutrophils and oval macrocytes. Which underlying condition is most likely?

Accepted Answer

Folate Deficiency

Answer

Iron Deficiency Anemia

Answer

Lead Poisoning

Answer

Thalassemia

Question 7

A peripheral blood smear shows target cells, poikilocytosis, and basophilic stippling. Which condition is most likely associated with these findings?

Accepted Answer

Thalassemia

Answer

Iron Deficiency Anemia

Answer

Sideroblastic Anemia

Answer

Pernicious Anemia

Question 8

A 28-year-old woman presents with intermittent fever and joint pain. A biopsy of the lymph node reveals large, binucleated cells with prominent nucleoli. Which diagnostic test would confirm the probable diagnosis?

Accepted Answer

CD30 and CD15 immunohistochemistry

Answer

Bone marrow biopsy

Answer

Serum lactate dehydrogenase

Answer

Peripheral blood smear

Question 9

Which of the following conditions is associated with elevated leukocyte alkaline phosphatase levels?

Accepted Answer

Polycythemia vera

Answer

Pernicious anemia

Answer

Sickle cell anemia

Answer

Plummer-Vinson syndrome

Question 10

A 70-year-old man presents with weight loss, night sweats, and an abdominal mass. A CT scan reveals a large mesenteric mass, and a biopsy shows sheets of large lymphoid cells. What is the likely diagnosis?

Accepted Answer

Non-Hodgkin lymphoma

Answer

Multiple myeloma

Answer

Chronic lymphocytic leukemia

Answer

Hodgkin lymphoma

Hematopathology — MCQs

Hematopathology — MCQs

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